Severe Condylar Degeneration of a Male, Age 39 

Here is an ICAT panoramic image showing both TM joints. Right joint (on the left) shows severe condylar degeneration. Doctors told patient he has no disc…case hopeless. Patient didn’t believe everything he heard and read…persisted to find better answers. This is an asymmetric TMD joint cases.

We treated effectively with lower removable GNM orthotic following strict procotols. Patient after a couple of years was accurately transitioned after being free of pain symptoms with ortho corrected a retruded maxilla and Class III tendency jaw relationship. Patient is now stable and free of years of pain… no crowns, restored severe worn teeth with bonded surfaces over his teeth based on K7 and TENS to optimized bite and asymmetric worn down condyles. Used anatomical GNM orthotic.

PATIENT REPORTED THE FOLLOWING PREVIOUS SYMPTOMS:

• Headpain: YES Frontal: YES
• Temporal: YES, BILATERAL
• Back of head: YES
• Jaw joint pain:YES
• Facial pain: YES – MODERATE, NOT SURE IF FACIAL OR HEADACHES
• Clicking and /or popping in right TMJoint – YES, IT FEELS STUCK
• Clicking and/or popping in left TMJoint– YES, OCCASIONALLY
• Clicking and/or popping in TMJoints – bilateral– YES
• Tinnitus:- NO
• Earache: – NO, ITCHY EARS, BILATERAL
• Stuffiness:OCCASIONALLY, NOSE REGION
• Neckaches:YES, CHRONIC FOR THE PAST 20 YEARS.
• Stiff Neck:YES, SEE ORTHOPEDIC DR. WANTED TO CUT SENSORY NERVES TO NECK
• Shoulder pain: YES BILATERAL
• Pain and/or pressure behind eye: YES, BILATERAL
• Visual disturbances: YES, FEELS THINGS GO SIDE WAYS
• Numbness and/or tingling in hands and/or fingers: PAIN IN HANDS BILATERAL
• Odontalgia: YES, SEVERE LOWER LEFT SECOND MOLAR
• Clenching and/or grinding teeth during the day – NO
• Clenching and/or grinding teeth during the night – YES, WITH PREVIOUS ORTHOTICS
• HE CLENCHED, WITHOUT ORTHOTIC NO CLENCHING, BUT TONGUE POSITIONED BETWEEN TEETH
• Awaking with jaws clenched – YES, JAW NEVER FEELS GREAT, CHRONIC, NO SHARP PAIN, BUT TERRIBLE.
• Hearing change:NO
• Chronic Sinusitis: – SEEMS LIKE SINUS HEADACHE
• Vertigo:YES
• Nausea:YES
• Difficulty/pain in opening mouth – YES, KIND OF STUCK, RIGHT SIDE FEELS STUCK, “SWOLLEN”
• Difficulty/pain in closing mouth – NO, TEETH DON’T TOUCH ON RIGHT SIDE
• Mouth “locks” open/closed – NO
• Pain and/or difficulty chewing – YES
• Pain and/or difficulty swallowing – NO
• Right foot arch is painful – medial arch pinching (Dx planters fasiatis) to hip that is out.
• Right groan area sore an painful.

Four consecutive open closing dynamic K7 ESG (electrosonography) joint sound recordings were capture and recording of both the left and right temporomandibular joints.  Velocity, timing, amplitude, duration and frequency patterns were also accurately documented and used to detect high and low frequency signature sound patterns.  Severe degenerative joint (DJD) was confirmed and noted by high frequency, low amplitude signature joint sound patterns (bone grating on bone).  Late closing click on the right TM joint is considered non reducing or the disc is not recapturing.

Recording of joint sounds is part of a recommended screening examination for TMD patients and is the “standard of care” during examination of TMD patients.  Standards for the history, examination, diagnosis and treatment of temporomandibular distorders (TMD) published by the American Academy of Head and Neck and Facial Pain indicates (1990), “Digital Sonography may be used to record and analyze temporomandibular joint sounds providing the doctor with valuable information for diagnosis and treatment planning”.

Day 2 of GNM Anatomical Lowr Orthotic Treatment: Shoulder/neck on right side which was sore for many years was reported 80-90 % improved since wearing GNM micro adjusted orthotic. After orthotic re delivered and adjusted that his neck pain in the occiput is greatly diminished.

• Almost no pain in the right joint and posterior border of mandible region.  Neck pain almost all gone.
• Significant improved compared to before.
• No pain in legs after SOT and AO adjustment.
• Patient is able to left both legs like before
• No pain in groan region on right side.

6 years has elapsed now and patient is pain free and doing well. Patient is completing his ortho and biomimetically restoring his severely worn posterior teeth…with no cutting of his teeth, no crowns. Optimized bite has been established using K7 and TENS to accurately assist in diagnosis to find the correct jaw and joint relationship in spite of joint condylar condition which was indicated hopeless by experts. Patient no longer complaints of joint problems or mandibular functional problems. He is able to chew comfortable, free of pain.

After GNM Orthodontics and Biomemetic Treatment

Orthodontic expansion both maxillary and mandibular arch was accomplished following GNM orthopedic lower posterior verticalization (non surgically).  Worn occlusal surfaces were also rejuventate with out non prepared occlusal surfaces (conservatively) using biomemetic minimal prep techniquess to purpsely conservate and restore severely worn occlusal surfaces.  Lower anterior teeth were verticalized to the new occlusal plane to complete the occlusal TMD stablization process following both gnathic and neuromuscular  (GNM) methodologies.

Worn Occlusal Surfaces Before Treatment

Rejuvenated (No crown prep) Occlusal Surfaces After GNM Treatment

Diagnosis is key, conservative, no surgery, removable and non invasive. Patient not taking any pain medications a total believer in GNM dentistry.